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High-Dose Magnesium Sulfate Infusion for Severe Asthma in the Emergency Department: Efficacy Study
Jose E Irazuzta1, Fatima Paredes, Viviana Pavlicich
11Wolfson Children's Hospital, Jacksonville, FL. 2Hospital General Pediátrico Niños de Acosta Ñu, Asunción, Paraguay.
Insights
High-dose prolonged magnesium sulfate infusion significantly improves asthma outcomes. This treatment expedites emergency department discharges and reduces healthcare costs for severe asthma patients.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Pharmacology
Background:
- Severe asthma exacerbations in children require effective treatment strategies.
- Standard therapy may not be sufficient for all pediatric asthma patients.
- Magnesium sulfate is a potential bronchodilator for severe asthma.
Purpose of the Study:
- To evaluate the efficacy of a high-dose, prolonged magnesium sulfate infusion in pediatric patients with severe, noninfectious-mediated asthma.
- To compare this treatment to a standard bolus infusion.
Main Methods:
- A prospective, randomized, open-label study was conducted in a pediatric emergency department.
- Patients aged 6-16 years, unresponsive to 2 hours of standard asthma therapy, were enrolled.
- Participants received either a magnesium sulfate bolus (50 mg/kg over 1 hour) or a high-dose prolonged infusion (50 mg/kg/hr for 4 hours).
Main Results:
- The high-dose prolonged infusion group showed a significantly higher discharge rate at 24 hours (47% vs. 10%, p=0.032).
- Patients receiving the prolonged infusion had a shorter hospital length of stay (34.13 hrs vs. 48.05 hrs, p=0.013).
- The cost per patient was significantly lower in the high-dose prolonged infusion group (one-third reduction).
Conclusions:
- High-dose prolonged magnesium sulfate infusion is an effective treatment for severe, noninfectious-mediated asthma in children.
- This therapeutic approach accelerates emergency department discharges.
- The treatment offers substantial reductions in healthcare costs.
Objective:
To assess the efficacy of a high-dose prolonged magnesium sulfate infusion in patients with severe, noninfectious-mediated asthma.
Design:
Prospective, randomized, open-label study.
Setting:
Twenty-nine-bed pediatric emergency department located in a children's hospital in Asuncion, Paraguay.
Patients:
All patients of 6-16 years old who failed to improve after 2 hours of standard therapy for asthma.
Interventions:
Subjects were randomized to receive magnesium sulfate, 50 mg/kg over 1 hour (bolus) or high-dose prolonged magnesium sulfate infusion of 50 mg/kg/hr for 4 hours (max, 8.000 mg/4 hr). Patients were monitored for cardiorespiratory complications.
Measurements And Main Results:
Asthma severity was assessed via asthma scores and peak expiratory flow rates at 0-2-6 hours. The primary outcome was discharge to home at 24 hours. An analysis of the hospital length of stay and costs was a secondary outcome. Thirty-eight patients were enrolled, 19 in each group. The groups were of similar ages, past medical history of asthma, asthma score, and peak expiratory flow rate. There was a significant difference in the patients discharged at 24 hours: 47% in high-dose prolonged magnesium sulfate infusion (9/19) versus 10% (2/21) in the bolus group (p = 0.032) with an absolute risk reduction 37% (95% CI, 10-63) and a number needed to treat of 2.7 (95% CI, 1.6-9.5) to facilitate a discharge at or before 24 hours. The length of stay was shorter in the high-dose prolonged magnesium sulfate infusion group (mean ± SD in hr: high-dose prolonged magnesium sulfate infusion, 34.13 ± 19.54; bolus, 48.05 ± 18.72; p = 0.013; 95% CI, 1.3-26.5). The cost per patient in the high-dose prolonged magnesium sulfate infusion group was one third lower than the bolus group (mean ± SD: high-dose prolonged magnesium sulfate infusion, $603.16 ± 338.47; bolus, $834.37 ± 306.73; p < 0.016). There were no interventions or discontinuations of magnesium sulfate due to adverse events.
Conclusions:
The early utilization of high-dose prolonged magnesium sulfate infusion (50 mg/kg/hr/4 hr), for non-infectious mediated asthma, expedites discharges from the emergency department with significant reduction in healthcare cost.
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